Reviewed and approved by the AAEM Board of Directors 2/14/2010.
- Define the Issue and State the Question
- A. Topic Area: _______Pediatric fever_____________
- B. General Issue: __Urinary tract infection ___________
- C. Specific Question: _Does the urine dipstick and or the urine microanalysis correlate with a culture positive UTI in febrile children?
- D. Executive Summary: Fever from a urinary tract source remains the predominant etiology of serious bacterial infection in the child who is 0-36 months of age. Our review of the available literature suggests that febrile children (> 38.0 celsius) who are 0-28 days old (and usually up to 60 – 90 days old) will still require a full septic work-up even if the urinalysis is strongly suggestive of a UTI due to the possibility of concomitant meningitis or bacteremia. In febrile children (> 39.0 celsius) 2-24 months of age with no obvious fever source, a urinary source should be investigated if the child is female, males < 6 months old, or any uncircumcised male. When collecting a urine sample from any child 0-36 months, obtain a catheterized specimen to minimize false positive results. A tentative diagnosis of UTI from this specimen can be made if the sample is positive for nitrites, has greater than trace leukocyte esterase, or has bacteria on gram stain. In these cases antibiotics should be initiated. A urine culture should be sent for all specimens; however if the urinalysis is negative for nitrites with zero or trace leukocyte esterase and no bacteria on gram stain, an alternate fever source should be considered while the urine culture is pending.